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The Vulvar Vestibule, a Small Tissue with a Central Position: Anatomy, Embryology, Pain Mechanisms, and Hormonal Associations

  • Urology, Gynecology, and Endocrinology (J Simon and M Luria, Section Editors)
  • Published:
Current Sexual Health Reports Aims and scope Submit manuscript

Abstract

The vulvar vestibule is the tissue located between the vagina and the vulva, comprising the vaginal introitus. It is mainly considered in the context of localized provoked vestibulodynia, a pain condition causing dyspareunia in 8–16% of women.

Purpose of Review

To describe the vulvar vestibule’s unique properties, which may have a role in the development of vestibular tenderness and dyspareunia.

Recent Findings

The vestibule displays different neural features when compared with neighboring organs. It is an immunologically diverse tissue that exhibits highly localized and tissue-specific pro-inflammatory responses. Systemic, as well as local hormonal-associated processes regarding estrogen, androgens, and usage of hormonal contraception apear to influence the pain threshold in the vestibule.

Summary

The vestibule, emerging from the embryonic endoderm, exhibits unique features regarding innervation, inflammation, and hormonal stimuli. A better understanding of these mechanisms is required in order to advance our understanding of introital dyspareunia.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

    Ahinoam Lev-Sagie & Ronit Gilad

  2. Department of Pathology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

    Diana Prus

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  1. Ahinoam Lev-Sagie
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Correspondence to Ahinoam Lev-Sagie.

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Ahinoam Lev-Sagie, Ronit Gilad, and Diana Prus each declares that they have no potential conflicts of interest.

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Lev-Sagie, A., Gilad, R. & Prus, D. The Vulvar Vestibule, a Small Tissue with a Central Position: Anatomy, Embryology, Pain Mechanisms, and Hormonal Associations. Curr Sex Health Rep 11, 60–66 (2019). https://doi.org/10.1007/s11930-019-00193-z

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